A comprehensive review of the English literature evaluating streptokinase (SK) in the treatment of deep venous thrombosis (DVT) of the lower extremity reveals complete lysis of thrombi in as many as 70% of patients studied. The degree of lysis is affected by duration of symptoms before treatment, degree of occlusion, thrombus location, and development of a plasma proteolytic state. SK-treated patients have not been found to have a greater incidence of major hemorrhagic complications when compared with heparin-treated patients. SK is clearly beneficial in the treatment of DVT if patients are properly selected and carefully managed. Proper patient selection and a recommended treatment protocol are described. © 1990.